Beliefs and attitudes regarding prenatal marijuana use: Perspectives of pregnant women who report use

OBJECTIVE

With the increasingly permissive legal and social environments regarding marijuana, it is important to understand prenatal marijuana use from the perspective of women who use marijuana. Our objective was to qualitatively describe the marijuana use experiences, beliefs, and attitudes of women who used marijuana during pregnancy.

METHODS

We conducted semi-structured interviews with pregnant women who had either reported current marijuana use or had urine testing positive for marijuana. Interviews were transcribed verbatim and analyzed for patterns and themes.

RESULTS

Twenty-five pregnant women who used marijuana during their pregnancies participated in our study interviews. Main themes that emerged from the interviews were that women: 1) reported higher amounts of marijuana use prior to pregnancy and attempted to reduce their use once they realized they were pregnant; 2) used marijuana to help with nausea and appetite changes during pregnancy or to improve mood; 3) described marijuana as "natural" and "safe" compared to other substances such as alcohol, tobacco, other recreational drugs, and prescribed medications; 4) had conflicting opinions regarding whether marijuana was addictive; and 5) were uncertain but had some concerns regarding potential risks of prenatal marijuana use.

CONCLUSION

Pregnant women who used marijuana in pregnancy held contradictory beliefs about continued use; they reported trying to reduce usage and were worried about potential risks, but also felt that marijuana is more natural and safer than other substances, including prescribed medicines. These findings have implications for how practitioners address prenatal marijuana use and highlight the need for further research on developmental outcomes.

Media portrayal of prenatal and postpartum marijuana use in an era of scientific uncertainty

BACKGROUND

Objectives were to characterize how scientific information about prenatal and postpartum marijuana use was presented in online media content, and to assess how media portrayed risks and benefits of such marijuana use.

METHODS

We analyzed online media items (n = 316) from March 2015 to January 2017. A codebook was developed to measure media content in 4 domains: scientific studies, information about health and well-being, mode of ingestion, and portrayal of risks and benefits. Content analysis was performed by two authors, with high inter-rater reliability (mean ĸ = 0.82). Descriptive statistics were used to characterize content, and regression analyses were used to test for predictors of media portrayal of the risk-benefit ratio of prenatal and postpartum marijuana use.

RESULTS

51% of the media items mentioned health risks of prenatal and postpartum marijuana use. Nearly one-third (28%) mentioned marijuana use for treatment of nausea and vomiting in pregnancy. Most media items mentioned a specific research study. More than half of media (59%) portrayed prenatal or postpartum marijuana risks > benefits, 10% portrayed benefits> risks, and the remainder were neutral. While mention of a scientific study was not predictive of the portrayal of the risk-benefit ratio of marijuana use in pregnancy or postpartum, discussion of health risks and health benefits predicted portrayals of the risk-benefit ratio.

CONCLUSIONS

Online media content about prenatal and postpartum marijuana use presented health risks consistent with evidence, and discussed a health benefit of marijuana use for nausea and vomiting in pregnancy. Portrayal of risks and benefits was somewhat equivocal, consistent with current scientific debate.

Perinatal Illicit Drug and Marijuana Use

PURPOSE

To assess use, screening, and disclosure of perinatal marijuana and other illicit drugs during first obstetric visits.

DESIGN

Observational study that qualitatively assesses provider screening and patient disclosure of substance use.

SETTING

Study sites were five urban outpatient prenatal clinics and practices located in Pittsburgh, Pennsylvania.

PARTICIPANTS

Pregnant patients and obstetric providers were recruited as participants.

METHODS

We audio recorded patient-provider conversations during first obstetric visits and obtained patient urine samples for drug analyses. Audio recordings were reviewed for provider screening and patient disclosure of illicit drug use. Urine analyses were compared with audio recordings to determine disclosure.

RESULTS

Four hundred and twenty-two pregnant patients provided complete audio recordings and urine samples for analyses. Providers asked about illicit drug use in 81% of the visits. One hundred twenty-three patients (29%) disclosed any current or past illicit drug use; 48 patients (11%) disclosed current use of marijuana while pregnant. One hundred and forty-five samples (34%) tested positive for one or more substances; marijuana was most commonly detected (N = 114, 27%). Of patients who tested positive for any substance, 66 (46%) did not disclose any use; only 36% of patients who tested positive for marijuana disclosed current use.

CONCLUSION

Although marijuana is illegal in Pennsylvania, a high proportion of pregnant patients used marijuana, with many not disclosing use to their obstetric care providers.

"Anything above marijuana takes priority": Obstetric providers' attitudes and counseling strategies regarding perinatal marijuana use

OBJECTIVE

To describe obstetric provider attitudes, beliefs, approaches, concerns, and needs about addressing perinatal marijuana use with their pregnant patients.

METHODS

We conducted individual semi-structured interviews with obstetric providers and asked them to describe their thoughts and experiences about addressing perinatal marijuana use. Interviews were transcribed verbatim, coded and reviewed to identify themes.

RESULTS

Fifty-one providers participated in semi-structured interviews. Providers admitted they were not familiar with identified risks of marijuana use during pregnancy, they perceived marijuana was not as dangerous as other illicit drugs, and they believed patients did not view marijuana as a drug. Most provider counseling strategies focused on marijuana's status as an illegal drug and the risk of child protective services being contacted if patients tested positive at time of delivery.

CONCLUSIONS

When counseling about perinatal marijuana use, obstetric providers focus more on legal issues than on health risks. They describe needing more information regarding medical consequences of marijuana use during pregnancy.

PRACTICE IMPLICATIONS

Provider training should include information about potential consequences of perinatal marijuana use and address ways to improve obstetric providers' counseling. Future studies should assess changes in providers' attitudes as more states consider the legalization of marijuana.

Pregnant Women's Access to Information About Perinatal Marijuana Use: A Qualitative Study

BACKGROUND

Marijuana is the most commonly used illicit substance in pregnancy. Little is known about how pregnant women who use marijuana obtain and understand information about perinatal marijuana use. We conducted a qualitative study among pregnant women who had used marijuana to understand their information-seeking patterns and perceptions of usefulness of available information about perinatal marijuana use.

STUDY DESIGN

We conducted semistructured interviews with 26 pregnant women who were receiving prenatal care and who either disclosed marijuana use or had urine samples testing positive for marijuana. Interviews assessed women's sources of information about risks of perinatal marijuana use and perceptions regarding the usefulness of such information. Interview data were coded independently by two coders who iteratively refined the codes and reviewed transcripts for themes.

RESULTS

Commonly reported sources of information about perinatal marijuana use included Internet searching and anecdotal experiences or advice from family or friends. Few women reported receiving helpful information from a health care provider or social worker. Women perceived a lack of evidence about harms of perinatal marijuana use, and reported being dissatisfied with the quality of information. Most women said they desired information about the effects of perinatal marijuana use on infant health.

CONCLUSIONS

Women who used marijuana before or during pregnancy did not find available information about perinatal marijuana use to be useful, and sought more information pertaining to infant health and well-being. Efforts to reduce perinatal marijuana use should focus on addressing this need in both clinical and public health settings.

Obstetric Health Care Providers' Counseling Responses to Pregnant Patient Disclosures of Marijuana Use

OBJECTIVE

To describe obstetric health care providers' responses and counseling approaches to patients' disclosures of marijuana use during first prenatal visits.

METHODS

We performed a content analysis of audio-recorded patient-health care provider first prenatal visits for obstetrics health care providers' responses to patients' disclosure of marijuana use. The study was conducted at five urban outpatient clinics located in Pittsburgh, Pennsylvania.

RESULTS

Among 468 audio-recorded first obstetric encounters, 90 patients (19%) disclosed marijuana use to 47 health care providers; mean number of recoded encounters containing marijuana disclosures for participating health providers was 1.8±1.4. In 48% of these 90 visits, obstetric health care providers did not respond to marijuana use disclosures or offer counseling. When counseling was offered, it consisted of general statements without specific information on the risks or outcomes related to marijuana use in pregnancy, discussions regarding the need for urine toxicology testing, and warnings that use detected at the time of delivery would initiate child protective services involvement.

CONCLUSION

Obstetric health care provider responses to disclosure of marijuana use occurred in approximately half of patient encounters when marijuana use was disclosed and focused on legal and procedural consequences with less focus on health or medical implications. Our results suggest a need for health care provider training on potential consequences of perinatal marijuana use and communication skills for counseling patients about perinatal marijuana.

Characteristics of breastfeeding discussions at the initial prenatal visit

OBJECTIVE

To describe the observed characteristics of first prenatal visit breastfeeding discussions between obstetric providers and their pregnant patients.

METHODS

This analysis was part of a larger study involving 69 health care providers and 377 patients attending their initial prenatal visits at a single clinic. Audio recordings and transcripts from the first 172 visits (including 36 obstetric-gynecology residents, six nurse midwives, and five nurse practitioners) were reviewed for breastfeeding discussion occurrence, timing and initiator of discussions, and adherence to American College of Obstetricians and Gynecologists (College) prenatal breastfeeding guidelines. Descriptive statistics were used to characterize the sample and frequency of breastfeeding discussions. Logistic regression and χ tests were used to examine patterns in women's breastfeeding discussion preferences and discussion occurrence. Conversations were qualitatively analyzed for breastfeeding content.

RESULTS

Breastfeeding discussions were infrequent (29% of visits), brief (mean 39 seconds), and most often initiated by clinicians in an ambivalent manner. Sixty-nine percent of breastfeeding discussions incorporated any College breastfeeding recommendations. Breastfeeding was significantly more likely to be discussed by certified nurse midwives than residents (odds ratio 24.54, 95% confidence interval 3.78-159.06; P<.01), and certified nurse midwives tended to engage patients in more open discussions. Women indicating a preference for breastfeeding discussions at the first visit (n=19) were more likely to actually have the discussion (P<.001).

CONCLUSION

Observed breastfeeding education at the first prenatal visit was suboptimal. The causes and effect of this deficiency on breastfeeding outcomes remains an important point of investigation.

LEVEL OF EVIDENCE

: II.

Reward-related brain function and sleep in pre/early pubertal and mid/late pubertal adolescents

PURPOSE

The onset of adolescence is a time of dramatic changes, including changes in sleep, and a time of new health concerns related to increases in risk-taking, sensation seeking, depression, substance use, and accidents. As part of a larger study examining puberty-specific changes in adolescents' reward-related brain function, the current article focuses on the relationship between functional neuroimaging measures of reward and measures of sleep.

METHODS

A total of 58 healthy participants 11-13 years of age completed a functional magnetic resonance imaging scan using a guessing task with monetary rewards and 4 days of at-home actigraphy and self-reported sleep ratings. Sleep variables included actigraph measures of mean weekend minutes asleep, sleep onset time, and sleep offset time, as well as self-reported sleep quality.

RESULTS

During reward anticipation, less activation in the caudate (part of the ventral striatum) was associated with fewer minutes asleep, later sleep onset time, and lower sleep quality. During reward outcome, less caudate activation was associated with later sleep onset time, earlier sleep offset time, and lower sleep quality.

CONCLUSIONS

It has been hypothesized that adolescents' low reactivity in reward-related brain areas could lead to compensatory increases in reward-driven behavior. This study's findings suggest that sleep could contribute to such behavior. Because decreased sleep has been associated with risky behavior and negative mood, these findings raise concerns about a negative spiral whereby the effects of puberty and sleep deprivation may have synergistic effects on reward processing, contributing to adolescent behavioral and emotional health problems.

Industrial wastes and public health: some historical notes, Part I, 1876-1932

This article has focused on the relatively low priority accorded industrial wastes compared to human wastes by the public health community in the period from 1876 through 1932. The critical reason for this prioritization was the potential for acute health effects from human wastes as compared with the belief that industrial wastes had only indirect effects. State departments of health normally only responded to industrial wastes when they endangered the potable nature of water supplies or interfered with water and sewage treatment processes. Within the public health community, however, a relatively small group of interdisciplinary professionals argued for attention to the indirect health effects of industrial wastes and their impacts on the total stream environment. In conjunction with other groups interested in clean streams--such as sportsmen and manufacturers who required high quality process water--they pushed for a broader state legislative mandate in regard to pollution control. Some states created new bureaus or boards with responsibility for industrial wastes and the larger stream environment but the attack on industrial pollution remained limited in this period. The final significant development regarding industrial pollution and public health concerned the formulation by Streeter-Phelps of the Public Health Service of a theory of stream purification with a set of general quantitative indicators. This application was of particular importance in regard to the high-oxygen consuming nature of organic industrial wastes and the wide variety of effluents that existed. Industrial wastes constituted what Harvey Brooks, in his essay "Science Indicators and Science Priorities" calls a very "messy" research problem--one that does "not lend itself to elegant and widely applicable generalizations."(ABSTRACT TRUNCATED AT 250 WORDS)